Provider Demographics
NPI:1073582748
Name:GEORGE, LADONNA DICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LADONNA
Middle Name:DICHELLE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:AR
Mailing Address - Zip Code:71671-2719
Mailing Address - Country:US
Mailing Address - Phone:870-226-2112
Mailing Address - Fax:870-226-2987
Practice Address - Street 1:302 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:AR
Practice Address - Zip Code:71671-2719
Practice Address - Country:US
Practice Address - Phone:870-226-2112
Practice Address - Fax:870-226-2987
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1823207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134937001Medicaid
AR134937001Medicaid
AR5K912Medicare PIN